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At Anchor Counseling: Therapy is Designed for You!

Oct 26, 2011   //   by Richard Figueira   //   Blog, East Providence, Lincoln, Rhode Island, cranston  //  No Comments

Therapy Designed For You


At Anchor Counseling Center we find that, initially, many of our clients fear being labeled with a psychological disorder or even a learning disability. Most people are fearful of the stigmas associated with having a psychological problem or having to get help in order to overcome a personal problem. At Anchor, the clinicians don’t just give you a diagnosis and try to treat that diagnosis. While we may prescribe a psychiatric diagnosis, it only contributes to part of how we treat the individual as a whole in therapy.

In the famous study of psycho-diagnostic labels by Dr. David Rosenhan, eight pseudo-patients were committed to hospitalization. These “patients” claimed to “hear voices that said, ‘empty,’ ‘hollow,’ and ‘thud.’ Beyond this single symptom the pseudo-patients acted completely normal. Even though this was the only symptom exhibited and they otherwise acted perfectly normal, all eight were admitted, with all but one being prescribed the diagnosis of schizophrenia.  Once inside the hospital, the pseudo-patients acted completely normal—displayed no further symptoms. Each participant also took notes which were eventually perceived as another attribute of their diagnoses.  As a result, the participants were hospitalized for seven to fifty-two days—remaining virtually undetected by hospital staff (psychiatrist, nurses, etc.).  This study somewhat catapulted psychologists into realizing that a normal person versus a mentally ill person is not readily distinguishable. Many pseudo-patients reported that some of the actual patients were able to recognize them as “fake, or not crazy.” The reasoning for this is suggested by the data gathered for patient-to-staff contact/communication.  Approximately 71-88% of all hospital staff ignored patient inquires and/or questions.  Between 23 and 10% of the staff would actually avoid eye contact.  There was also an incident of a female nurse adjusting her bra in front of male patients—as if they weren’t real beings.  This implies that because of limited contact with patients, many misdiagnoses go unnoticed. Also, it suggests that focusing on one symptom of a potential patient, as opposed to several behaviors, can be misguiding or overly suggestive. Once these pseudo-patients were given a diagnosis (schizophrenia),that became the “central characteristic of the individual.” Labels tend to suggest, and once a person knows what someone else’s label is they then begin to perceive their behavior as an attribute of the label.  The staff in this instance perceived the note-taking as a part of the pseudo-patients illness regardless of the fact that the ‘patients’ acted otherwise normal.

The reversal of the study also offered proof that distinguishing the normal from the mentally-ill is difficult. Many hospitals/institutions claimed to interview numerous pseudo and possible pseudo-patients when Dr. Rosenhan had in fact sent no pseudo-patients. Frankly, we have no concrete way of knowing who is normal versus who is abnormal, especially on the basis of one behavior. The key is asserting that there is plenty of room for misdiagnosis and to watch, study, and communicate (ask questions) with patients in order to know whether re-evaluation is necessary.  Also, greater awareness of labeling dangers is keen in order to dismantle one’s own biases and focus on the actual happenings of the patient.  Finally, rather than focusing on just one component of an illness, the broader spectrum of the illness should be scrutinized with regards to the patient. Does his/her behavior fit more than one characteristic of the illness? What other behaviors do you notice? What are some behaviors he/she exhibits that are normal? Because normality and abnormality lie on a spectrum, things such as levels of bizarreness, persistence, social deviance (cultural deviance), subjective distress, and psychological handicap must all be assessed.

The Therapists at Anchor Counseling Center are dedicated to treating you on a holistic level—we don’t just treat the problem. We pay attention to diagnostic-labels and their associated stigmas, and while we may prescribe a diagnosis we are open to client’s thoughts and questions as to whether that diagnosis is correct. If you feel that you need help getting through a problem or have previously been diagnosed with a psychiatric disorder but feel like nothing is changing, please give us a call at Anchor Counseling Center and schedule an appointment.

*For more information on Dr. Rosenhan’s study view:

http://www.bonkersinstitute.org/rosenhan.html

What is OCD?

Oct 25, 2011   //   by Richard Figueira   //   Blog, East Providence, Lincoln, Rhode Island, Mental Health, cranston  //  No Comments

Obsessive-Compulsive Disorder

As clinicians at Anchor Counseling Center, a question we don’t often hear anymore is, “what exactly is obsessive-compulsive disorder?” Many times we see character depictions of an individual with OCD, such as Nicholas Cage in “Matchstick Men,” or Jack Nicholson in “As Good as it Gets,” but is that really what having OCD is like? Most people don’t actually realize that an obsessive-compulsive disorder does not look the same for every one person. Generally when we hear OCD we picture someone constantly cleaning for fear of attacking germs, or an anal retentive person that must have everything symmetrically in order. Neither of these illustrations should go unnoticed when considering an OCD diagnosis; however, an obsessive-compulsive disorder takes on many forms.  You may recall San Francisco Detective Adrian Monk from the television show Monk and his obsessive-compulsive cleaning behaviors.  For some people, OCD can be that severe, or disruptive to their daily lives. However, according the Diagnostic Manual used by psychologists, OCD can be defined by either obsessions or compulsions and obsessions—you don’t necessarily have to have both.

Obsessions are generally viewed as recurrent and persistent thoughts, images, or impulses that the individual deems intrusive and/or inappropriate. Take for example, Joe Smith. Mr. Smith comes into therapy because his wife says he refuses to help with their newborn child—he even avoids being left alone with the baby.  Mr. Smith then tells the therapist that he has persistent thoughts that he will hurt his infant child, despite the fact that he doesn’t think he could ever hurt his kid, the thoughts still persist.  As seen with Mr. Smith, obsessive thoughts are not extreme real-life worries; they are thoughts, impulses, or images the everyday person does not encounter consistently.

Compulsions, on the other hand, are repetitive behaviors or mental acts that the person does to reduce the anxiety produced by an obsession or prevent some dreaded event from occurring. There have been clients who’ve feared that unless they closed a door eight consecutive times, the house would be robbed while he/she is gone. Other clients have feared that they would hurt themselves even though they didn’t have the desire to die, and to reduce the distress from that thought he/she would repeat the same word twelve times and then be okay.  Other repetitive behaviors include, hand washing, placing things in specific orders, checking and rechecking items (i.e. the door is locked, the lights are off).  Most people don’t think about compulsions as mental acts, but they can include counting or repeating words/phrases silently.

Two other important aspects of OCD is that these obsessions or compulsions are time consuming, and that at some point the individual does recognize the obsessions/compulsions as excessive or unreasonable (usually adults). Many OCD clients will describe their thoughts and compulsions as making “no sense.” Often-times clients feel frustrated because the thoughts and impulses continue to persist even though they know that it’s an illogical thought.  The more severe the case of OCD the more time-consuming the thoughts and compulsions are.  It’s important to recognize how much time acting out the compulsive behaviors takes from your daily routine or how much it interferes with your ability to do your job (or school work) and your ability to function in social or relational situations.

At Anchor Counseling Center we treat many clients suffering from OCD, and we know that for many clients the first step to getting help may be embarrassing or distressing.  OCD is not a disorder that usually just disappears on its own, often times it will rear its ugly head again if the individual is not taught how to take control of his/her thoughts.  At Anchor, we use a variety of techniques to first reveal clients thinking and behavior patterns to themselves, teach them how to address their thought process and adjust their behavior accordingly, and finally we allow them to experience a new way of being. At Anchor we generally use cognitive behavioral therapy (CBT) in conjunction with exposure and response prevention therapy when possible. If you are struggling, and would like to take back control of your thoughts and behavior, please come see us at Anchor Counseling Center.

By: Aryssa Washington

References

Abramowitz, J. (2008). Obsessive-compulsive disorder. In E.Craighead, L. Craighead & D.Miklowitz, Psychopathology: History, Diagnosis, and Empirical Foundations (pp.159-191). Hoboken, NJ: John Wiley & Sons

Abramowitz, J., McKay, D., & Taylor, S. (2009). Obsessive-Compulsive Disorder. Lancet, 374,491–99

Coles, M. & Hayward, L. (2008). Elucidating the relation of hoarding to obsessive compulsive disorder and impulse control disorders. Journal of Psychopathology Behavioral Assesments, 31, 220-227. doi: 10.1007/s10862-008-9106-0.

Jane L Eisen; Meredith E Coles; M Tracie Shea; Maria E Pagano; et al (2006). Clarifying the convergence between obsessive compulsive personality disorder criteria and obsessive compulsive disorder. Journal of Personality Disorders; 20(3) 294-305.

Frost, R., Mataix-Cols, D. & Pertusa, A. (2010). When hoarding is a symptom of OCD: A case series and implications for DSM-V. Behaviour Research and Therapy, 48, 1012-1020.

Reality Therapy: Choosing Behaviors

Oct 13, 2011   //   by Richard Figueira   //   Blog  //  1 Comment

Choosing Behaviors to Impact Our External World: Reality Therapy

Anchor Counseling Center clinicians use an array of psychological theories and techniques to help their clients achieve a better quality of life. A more modern approach to psychotherapy that is currently taking notice is that of Choice Theory, also known as Reality therapy.

The History

William Glasser, MD, created reality therapy in the 1950s and 1960s while working in a correctional institution and a psychiatric hospital (Wubbolding, 2000).  Glasser was trained in psychoanalysis, but soon found that the goals of the analytic approach were attainable, but client’s ineffective behaviors persisted (Wubbolding, 2011). Glasser also observed that clients not only neglected to take responsibility for their behavior, but that they were also untrained in how to create more effective choices (Wubbolding, 2011). G.L. Harrington, Glasser’s professor and mentor, encouraged Glasser to generate and put into practice the early ideology of his new treatment. In Mental Health or Mental Illness, Glasser initially discussed his idea that the satisfaction of internal needs regulate an individual’s level of mental health (Wubbolding, 2011).

The defining moment of reality therapy came in 1965 with Glasser’s Reality therapy: A New Approach to psychiatry (Wubbolding, 2011).  In his newly identified therapy, Glasser highlighted that behavior is directly associated with one’s choices and that in most circumstances, people have various options available to them.  Glasser’s reality therapy was not initially received well by medical professionals, but others involved in corrections and the education system seemed intrigued by this methodology because it emphasized personal responsibility. Currently, when referring to reality therapy the associated theory is also implied; however, reality therapy was only seen as a method in the beginning.  Fascinatingly, the theory that applies to reality therapy was developed after the therapeutic methodology.

The early practice of reality therapy followed William James’ idea that attitudes are changeable, and therefore people can change their lives by changing their attitudes (Wubbolding, 2011). Psychoanalyst, Helmut Kaiser contributed to Glasser’s formulation of reality therapy by his admission that patients should feel responsible for their own words. Swiss physician, Paul Dubois, helped his patients substitute deconstructive thoughts with more constructive cognitions, which also contributed to the theory framing reality therapy. Glasser developed his basic premise when he consulted for the Ventura School, an institution for delinquent girls, in 1965.  The girls at the school had often been told that their emotional disorders rendered them irresponsible for their behavior, which Glasser disagreed with. Interest in the therapy practice gradually increased, but the need for a theoretical grounding was becoming an issue among those in the professional arena.  The William Glasser Institute, as it is currently named, was founded in 1967 and provides clinical training and certification in reality therapy for professionals.

In developing a fundamental theory, Glasser first formulated the sociological foundation in The Identity Society (Glasser, 1972).  This sociological foundation suggested that the gradual and sudden changes in societal values that impacted western civilization in the 1950s and 1960s birthed the “identity society” (Glasser, 1972).  The identity society referred to a society in which people’s central focus was on their identity development than on their basic needs (Glasser, 1972).  Emphasis was placed on personal empowerment by means of self-evaluation and positive future planning (Glasser, 1972). This notion was unique in comparison to the common practices of psychotherapy in the 1960s because it held people responsible for their behaviors. During that time in history, people seeking higher levels of inner control were, for the most part, the ones who approved of reality therap. Due to the concentration on personal responsibility, reality therapy was viewed as an internal control psychology. Glasser found that the control theory, or control system theory, was applicable to the practice of reality therapy. The assumptions of inner control formed the basis of choice theory, the theory that currently supports reality therapy.  The purpose of this paper is to discuss the underlying theory of reality therapy, the practice of reality therapy, and the therapy’s applicability and its efficacy as a therapy as it stands currently in the psychological field.

What is Choice Theory

Choice theory, previously known as the control system theory, explicates how the human mind functions as a negative input control system (Wubbolding, 2011).  The theory describes that when individuals perceive that they are not receiving what is desired, they display behavior, or trigger their behavioral system (Wubbolding, 2011).  Activation of the behavioral system occurs when the individual makes choices to correct the discrepancy between what they want or need and what they are not getting.  Mentally healthy humans are in a state of homeostasis when they perceive that their wants and needs are being satisfied by the world around them (Wubbolding, 2011). Glasser (1998) proposed that human behavior is both teleological and an individual’s attempt to influence and communicate with the external world. Reality therapy is rooted in choice theory, but maintains its own set principles and procedures as it predates choice theory. In any event, the aim of reality therapy is to change behaviors so that clients will experience need satisfaction and overall happiness. Wubbolding (2000), states that when clients’ needs are not being satisfied effectively, they will experience discomfort or a variety of emotions. Some people will develop psychosomatic symptoms or act out negatively when their needs repeatedly go unmet. Choice theory, is a system of brain functioning which Glasser (1998) adapted to his work with clinical patients and students. Control theory posits that the human brain works like a control system that seeks to regulate its own behavior which, in turn, alters the world external to the human being (Glasser, 1998; Wubbolding, 2011). Glasser’s (1998) extension of control theory, which includes five internal forces (needs) that motivate human beings, is what generated choice theory.  These five human needs, also known as “genetic instructions”, are inherent, general, and universal to all humans (Glasser, 1998).  Behavior is the individuals attempt to maintain or satisfy his or her needs for belonging or love, power or achievement, fun or enjoyment, freedom or independence, and survival (Wubbolding, 2011).  Effective satisfaction of the five needs results in a sense of control, equivalent with self-actualization or fully-functioning in other theories (Wubbolding, 2000).

Basic Needs and Feelings

The needs described by choice theory are similar to those presented by Maslow; however, needs in choice theory are not hierarchical, but function most effectively when all needs are equally balanced. Choice theory explains that all human beings strive to stay alive and reproduce. The inner functioning of an organism suggests that humans have a need for survival or self-preservation.  For example, the autonomic nervous system’s function is to maintain life and satisfy a person’s need for survival (Wubbolding, 2000).  The autonomic system keeps the body functioning, and many of the bodily functions require the help of the cerebral cortex. According to choice theory, “the cerebral cortex hoses the psychological needs and receives help-me messages from the autonomic system” (Wubbolding, 2000, p.11). This need functions at a level of awareness, regulates the individual’s voluntary behaviors, and attends to some less conscious, routine behaviors.

The need to belong is expressed by human beings tendency to congregate and form a sense of community.  This need is also evidenced by the fact that people quickly learn to cooperate with others and function as a unit. The workplace, school, church, and family are just a few of the places people find the need to belong satisfied. Glasser (1998) classified that the need for love or belonging operates effectively on a reciprocal basis. Psychotherapy shows clients how to lean on other people appropriately and how to make him or herself available to get love from another. Glasser (1998) stated that an excess of or excessive lack of love creates a self-absorbed, needy person or an insecure, always do-good person. People differ from one another by the individual’s efforts to establish and satisfy his or her identity needs (Glasser, 1972).  In reality therapy counseling, the quality of human relationships is the central focus in examining the individual’s need for belonging or love. Glasser (1998) pointed out that the need to belong is central to human motivation and how they relate with other people.  As long as clients can develop healthy human relationships, they can acquire the necessary means to satisfy their belonging needs.

Human beings also have a need for power in that they seek to gain power, achievement, competence and accomplishments.  Power, in choice theory, means “to be able “(Glasser, 1998, p.13).  While competition can definitely fulfill the power need, it is not the only way to acquire power.  Satisfying the power need should be viewed as an accomplishment or achievement (Glasser, 1998). In this sense, power is an internal feature; therefore, when one’s sense of power increases, it does not infringe upon the efforts of another person attempting to gain power.  According to Glasser (1998), attempting to achieve the need for power is a major cause of conflict in various societal settings such as schools, neighborhoods, and in families. Reality therapists assist clients in developing options that can fulfill their need for power without out impinging upon another’s efforts to do the same. Also, clients may experience the need for power as a need to feel inner control of their lives. Reality therapists assist clients in finding a balance of inner control as lives that are excessively regulated from the external world will often times rebel which is displayed by antisocial behavior, apathy, or negative symptoms (Glasser, 1998).

Freedom, or Independence, entails the notion that human beings have the chance to choose from varying possibilities and to act on one’s own without being unfairly restrained (Glasser, 1998).  Choice theory suggests that humans are born with the inclination to choose.  Most people who go into psychotherapy do not initially realize that they have the ability to make choices regardless of the circumstance. As with other needs, natural and circumstantial events (or objects) limit the ways in which the need can be fulfilled.  Despite even the direst situations, reality therapists deem that there is always a choice to be made by clients (Wubbolding, 2000, p.15).

The final need for fun and enjoyment is intrinsic to human nature. A person that chooses to be bored, lacks apathy or is “depress-ing” is not effectively fulfilling his or her need for enjoyment. According to Wubbolding (2000), “we are land-based creatures who play all our lives” (p.16).  In choice theory learning is associated with play, or fun.  Basically, humans are learning their entire life, but if humans were to discontinue playing they would also stop learning.  Fun is also related to building relationships. An example would be two people falling in love. People falling in love are essentially learning about each other, and often times they are seen by others as always laughing or having a good time with each other. Wubbolding (2000) says that “the developmental task of differentiating oneself from others entails the need for fun” (p.16). In couples counseling, reality therapists reveal options that help clients have fun and enjoy being together, as sharing fun with another increases intimacy. When a person participates in activities that are not at least tolerable, he or she may abandon the activities altogether or replace the activities with compensatory behaviors that are usually harmful.

McNamara (1997) expanded Glasser’s need system by suggesting that conflicts between needs can occur (as cited in Wubbolding, 2000).  This expansion suggests that one need may conflict with another, but also, tension can exist between aspects of the same need.  For example, a person’s need for survival may include the desire to be safe, but also the desire to grow and evolve.  The need for freedom can be freedom from something or the freedom to explore something.  While intra-need conflicts may exist, they are minute when compared to the true conflict expressed in the quality world of an individual.

Your Quality World

By interacting with the environment, people find that some aspects of the external world satisfy their needs, while other aspects of the world remain unsuccessful in fulfilling the five aforesaid psychological needs. From the external world experiences, the individual gathers information on what needs are and aren’t being met, and then he or she creates a file of wants (desires) in his or her mind. Each person generates particular images of people, events, beliefs, treasures, and activities that fulfill his or her needs (Glasser, 1998).  The collection of these need-fulfilling wants is the world in which a person desires to live (Glasser, 1998).  Choice theory describes the “quality world” as the conglomerate of wants as they relate to the five needs.  Every quality image, or want, is specific. Choice theorists call the specific wants, “pictures,” and the collective file of wants, the “mental picture album” (Glasser, 1998, p.53).  In general, people have ideas and beliefs about people who fulfill their needs for belonging, ideas about certain ways to gain power, and specific ideas about freedom. These specific ideas are exclusive to each individual.

Quality worlds are diverse, personally unique, and dynamic. According to choice theory, quality worlds adjust and evolve as people age and complete developmental tasks (Glasser, 1998).  Conflict may also exist among quality world wants. Quality world wants can be in conflict with each other, or these pictures can be in conflict with others wants. These conflicts often necessitate relationship, couples, or family therapy. The conflicts also imply that, in educational settings, teachers should attempt to become a part of their students’ quality worlds (Glasser, 1998).  Unfortunately, living completely in a quality world is impossible as humans actually fulfill needs in the real world (Glasser, 1998).  While pictures that make up the quality world are diverse, unique, and dynamic, they are also removable.  People even have the ability to remove others who are seen as important and lovable from their quality worlds. Glasser (1998) used the example of divorces.  He posited that the majority of marriages end because at least one partner changes the quality world pictures of his or her spouse (Glasser, 1998).

The pictures, or wants, of the quality world also exist as a set of priorities (Wubbolding, 2000).  Reality therapists spend a lot of time helping clients and students establish their priorities, or the level of importance associated with their wants. Wubbolding (2000) articulated that individuals brought up in chaotic, inconsistent, and dysfunctional families commonly express difficulties creating priorities and knowing the comparative importance of their wants. Unlike some choice theorists, Wubbolding (2000) held that some wants appear as blurred images in people’s brains. Just as a photograph can sometimes be blurry, the image of a want may present in the same manner because the individual may not have a clear idea of what he or she wants. Pictures, or wants, can either be attainable, unachievable, or in between. Unrealistic pictures are very common in psychotherapy. The first goal of psychotherapy is for the reality therapist to become a part of the client’s quality world so that clients will want to form a relationship with the therapist. Reality therapists have the job of helping people evaluate their current ability to achieve the particular want. Both Wubbolding (2000) and Glasser (1998) asserted that regardless of circumstances, an individual cannot be helped unless he or she chooses to be.

Regardless of what you are struggling with or what your wants are, we are here to respond to your needs. Anchor Counseling Center has over 20 clinicians in Cranston, East Providence, and Lincoln, RI that are dedicated to assisting you create change in your life that is fitting to your quality world.

References

Glasser, W. (1972). Identity society. New York: HarperCollins.

Glasser, W. (1995). Control theory: A new explanation of how we control our life. New York:

Harper & Row.

Glasser, W. (1998). Choice theory: A new psychology of personal freedom. New York, NY:

HarperCollins.

Wubbolding, R.E. (1988). Using reality therapy. New York, New York:  Harper & Row.

Wubbolding, R.E. (2011). Reality therapy. DC, Washington: American Psychological

Association.

Wubbolding, R.E. (2000). Reality therapy for the 21ST century. Philadelphia, PA: Taylor &

Francis.

Anger, Alone, Loneliness, and Sadness

Oct 12, 2011   //   by Richard Figueira   //   Blog, Uncategorized  //  No Comments

 Growing up with a brother that has autism was (and sometimes still is) difficult, confusing, and definately frustrating. I was always taught that I shouldn’t be angry for the things that my brother does because he “can’t help it” or the he “doesn’t understand”. I was taught to suppress my negative feelings towards my brother, and that nothing was ever his fault. Now that I’m given the chance to express these feelings, to acceptably  express these emotions that I have felt since i have been small child, a wave of emotion comes over me. And honestly, I dont where to start.

     It’s difficult to remember your childhood, to go all the way back to the beginning when no one really knew how to cope, how to deal with Jared. But I do have some memories that stick out that give me negative emotions. I remember being angry and confused as to why my brother got to go to these “play dates” and I didn’t ( I now know them as occupational therapy sessions). I remember having to go to many doctor’s appointments with my mom and brother, ones at Bradley( absolutely HATED these appointments) and ones at hospitals and different clinic type settings ( speech and physical therapy). It made me angry that I had to go.

     Because of my brother I had to talk to many people. Adults asking me to draw pictures, asking me how I was feeling, why I thought Jared was the way he was. I was angry and upset that I had to go to these people, angry that my mother wouldn’t listen to me when I told her I disliked going. I was never really told what autism was a child but people asked me what my thoughts to it was. Everything in my childhood was autism-based. We had forty hours of ABA in my house a week. Something that I couldn’t participate in, but tried to alot. I was alone and angry that I couldn’t participate in fun activities as I saw it. I had to sit in my room or downstairs in the living room while he had lessons.

     I also remember feeling sad, but I don’t remember why I was sad. I never slept well as a kid and remember lying in bed at night for hours staring at the ceiling until i finally fell asleep. Embarrassment was a negative feeling that took me a long time to get over also. I was told that I should never be embarrassed of my brother, but inside I was. I was embarrassed in the way he acted out, his behaviors, how he would take a tantrum when we sang happy birthday and everyone clapped(he hated loud noises). It made me sad and still does to this day how limited things are/were for him and how limited he is/was. I always think to myself, what if Jared was born without autism? What would my family be like? What would I be life? I contemplate this sometimes and I’m sure the rest of my family does too. I know I have more feelings, but I feel like I was told so much as a child not to be angry at him, that I need to understand his disabillity and move on from it, that I can’t be sad; that I think I have repressed alot of my negative feelings towards him all because I wasn’t allowed to.

Anchor Counseling joins Lincoln Pediatrics

Oct 12, 2011   //   by Richard Figueira   //   Blog, East Providence, Lincoln, Rhode Island, Mental Health, Uncategorized, cranston  //  No Comments

We have also partnered with Lincoln Pediatrics to provide more timely and on-site availability to counseling services.  Richard Figueira, LICSW, is the clinical director of Anchor Counseling. He will be providing on-site services at the North Attleboro office starting in November. We are excited about this new partnership with Lincoln Pediatrics. We believe it will be a win-win situation for our patients and for Lincoln Pediatrics.

Scattered Ashes

Sep 17, 2011   //   by Richard Figueira   //   Blog  //  No Comments

Scattered Ashes

By Aryssa Washington

The swirl of ashes gently caress the air we breathe,

the ground on which we walk.

In a silent slow dance, we move with the cadence of time

Hands linked at birth, we dance

I twirl, you hold on, you spin me around

You lead, I follow.

Hands twined by life, bound together, broken by death

I lose your hand

You meld into the dancing ashes,

All that’s left–you tinkling my fingers,

Covering my tears, my smile, my heart

Hands ripped from the grip of another

The connections severed, the love faded, the future ruined

I stand still

Hiding movement from the ashes pulling at my heart to dance

Another hand captures mine, another dance slowly begins

Whether I move or not the dance of death pushes me in motion

Pulls at me to dance among the ashes

The river of death flows through the hand linked to mine, linked to someone else’s

We are connected by the eventuality of the fall

Twinkling ashes slowly drawing us under, into the mist

Turning us to dust

A slow dance, A quick pace

The beauty of life in death

A dance from living to ashes, leaving trails, pulling at my hands

My feet begin to move

I twirl

I slowly dance again

You hold my hand, I spin you around

I lead, you follow

Slowly swirling to scattered ashes.

Taking culture into consideration during therapy!

Sep 17, 2011   //   by Richard Figueira   //   Blog, East Providence, Lincoln, Rhode Island, Mental Health, cranston  //  2 Comments

Multicultural Considerations in Therapy

Clinicians face an interesting task when diagnosing and treating a minority client especially when considering the clients cultural upbringing. The clinicians at Anchor Counseling Center express cultural acuity in their dedication to assisting all people despite race, gender, socioeconomic status, or sexual orientation.  Culture may be defined as “the quality in a person or society that arises from a concern for what is regarded as excellent in arts, letters, manners, education, religion, etc. (Webster’s Heritage Dictionary). A more common definition of culture is “the behaviors and beliefs characteristic of a particular social, ethnic, or age group.” Generally, culture is not measured effectively. For the most part it is measured by broad inquiries such as “what’s your religion, what is your socioeconomic status, and what is your race/ethnicity?” Questions of culture usually go no deeper than that, rendering the assessment inaccurate.

The only way to assess another’s culture with semblance of accuracy is to dig a little deeper, or rather, ask more in-depth questions (done in person is even better).  Questions may include: “1) What were your parents like? 2) How were you raised 3) Did you grow up with a certain belief system/has it changed? 4) What would you consider your socioeconomic status? 5) What ethnicity do you most associate with/why? 6) What is traditional and/or important to you?” These questions actually allow the clinician to get a snapshot of another’s life and/or thought process.  The more specific questions give a basis for understanding the individuals culture, as some aspects of their culture may not follow “culture-specific or culture-general belief systems” (Lopez, 2006 p. 16).

The cultural competence model proposed by Steve Lopez is a “model of cultural competence derived from research and clinical practice to serve as a guide in providing culturally appropriate mental health services for culturally diverse clientele” (23). His model recognizes that clients and clinicians have their own culture-specific perspectives. A culturally competent therapist is capable of moving (and deriving meaning) between the two different perspectives to form a beneficial treatment plan.  Lopez suggests that the cultural perspective operates in four different clinical domains: engagement, assessment, theory, and method.  Regarding engagement, “a culturally competent therapist is able to understand what the client views as the problem and what the client wishes to gain from therapy.”  Basically, the therapist gains understanding as to how the client perceives his/her issue. The client perceives the therapist as understanding his/her circumstance and the therapist has the job of assessing potential theoretical issues, diagnostic formulations and historical factors ( Lopez, 1997, 576).

The assessment dimension is really just the idea that when conducting formal or informal assessment procedures, the culturally competent therapist will consider mainstream cultural-specific norms and the norms specific to the client’s culture (577). And even though the DSM-IV offers clinicians the appendix of culture-bound syndromes, the appendix is limited in its applicability in relation to the numerous cultural differences that exist in America.  This acknowledgement of existing differences between mainstream and individual cultural norms helps to eliminate over-pathologizing or minimizing causation/diagnoses.  The third domain is theory, which generally explains the clients psychological functioning and how therapy works to change the behavior (579). Culturally competent clinicians recognize that clients may hold differing theoretical models which may be rooted in his/her culture. Assessing what the client believes to be the problem and ways the problem is maintained by his/her culture is beneficial. The idea is that the therapist integrates the client’s explanations with the theoretical model in order to get some positive effect. The last domain is the Methods, or procedures by which the clinicians use to facilitate change in their client (582). This is basically means that clinicians fit the method of treatment to what the client believes is helpful, or believes can work.  For example, if I am a patient with depression but my culture forbids drug therapy the therapist would direct me to alternative methods of treatment such as an exercise plan or maybe meditation etc., something I think is acceptable and will work.  Also, it is important that clinicians learn about culturally syntonic treatment methods for their clients in order to influence, or persuade them to try a method different than what they “know” (582).

There are several ways students and professionals can further their own degree of cultural competence.  The main idea that I came up with is to embark on a mission of self-discovery.  By this I mean an in-depth study of your life, perceptions and how others and how you think others may perceive you. Research your likes and dislikes about how you were raised and if you still hold similar beliefs or if they have changed. Only once we can somewhat understand our own cultures can we begin to try and see things form another perspective. It’s hard to imagine that we can try and know someone else if we don’t sort-of know ourselves.  Also understanding our own privileges can help put into perspective others who don’t have those privileges. Keep an open-mind and be aware of our own biases and stereotypes. Making the assumption that every client you meet is different from you helps eliminate biases and other assumptions you might make based on what you think you know.  I am also a firm believer in just getting out there and experiencing a different culture, being uncomfortable for five minutes won’t necessarily kill you.  Another means to become competent is to ask questions, if you truly don’t know, just ask. Most people would rather that you ask ‘with foot in mouth,’ as opposed to you operating on assumption.  It seems humiliating, but I have been on the receiving end of some ‘foot in mouth’ comments and most of the time it is a humorous experience as you know that the other person knows that he/she just said something really off the wall. I would recommend that we just try and remain humble beings and learn from one another. So whatever your race, gender, belief, background, or sexual orientation, we are here to assist you and your needs.  In helping individuals, children and families, the Anchor Counseling Center is always open to learning new things from the people we serve.

References

* Lopez, S. R. (1991).  Cultural sensitivity in clinical practice:  A process model.  California Psychologist, 24, pp. 14;23.

* Lopez, S. R. (1997). Cultural competence in psychotherapy: A guide for clinicians and their supervisors. In C. E. Watkins, (Ed.), Handbook of psychotherapy supervision, (pp. 570–588). New York: Wiley.

* Lopez, S. R., & GUARNACCIA, P. J. (2000). Cultural psychopathology: Uncovering the social world

of mental illness. Annual Review of Psychology, 51, 571–598.

Speech, Persuasion and Opinion: The Power of Language during therapy.

Sep 17, 2011   //   by Richard Figueira   //   Blog, East Providence, Lincoln, Rhode Island, Mental Health, Self Help, Stress, cranston  //  No Comments

The Power of Language and Therapy

In the famous speech, “Encomium of Helen,” Greek sophist, Gorgias, offers an undeniable level of understanding regarding speech, persuasion and opinion. Gorgias presents the idea that “speech is a powerful lord.”  I readily agree that with words comes power and with power comes a certain responsibility as the speaker or writer. Language is communication and on the most basic level of survival, communication in some way is necessary for all beings. The idea that I can elicit thoughts, actions, and change with words alone is powerful in itself.  Humans are taught and learn through language, whether it be written, spoken, or a modeled behavior.  We as human beings construct and utilize a communication system that allows us to categorize and make sense of things.  Once an individual is able to understand what the communication system entails, they can then use this language device to their advantage.  In many clinical settings, the aim of therapy is to have the client take control of his/her own actions and thoughts via language, speaking. In fact, most therapy sessions are carried out through conversational dialogue, or writing in journals, or even through the language of body positions. Gorgias’ claim fits perfectly with the more common quote that “with knowledge, comes power.”  Once I know what a certain communicating group of people considers true (right), acceptable, and worthwhile, then I can use words or communicating devices that I know will elicit specific reactions.  Power comes into play regarding speech in that I can totally construct an argument or proposition that can completely sway my audience in the direction of my choice via my language (word) selection and structure. In general, clinicians should have a great command of the therapeutic language, in that they can guide their clients to a place of understanding, change, and self-power. With this, however, comes a certain amount of integrity and responsibility on the part of the clinician, and trust, on the part of the clients.

One of the most striking lines in Gorgias’ speech says, “…but since opinion is slippery and insecure it casts those employing it into slippery and insecure successes.”  I will here pose the question, “what are our opinions, and what do they do?” Even if we base our decisions on empirical evidence this predicates the notion that said data is right or true, rendering our decisions based in opinion.  Our opinions in the realm of reality are nothing but a guide for our own individual souls.  Our opinions are ever-changing and are rarely ever concrete which means the opinion is susceptible to the power of words. Clinicians, like any human being, do have their own opinions, but those opinions should only guide them. Great clinicians are able to use their own opinions to guide themselves in therapy, yet listen and utilize the opinions of the client to assist him/her in his/her situation. Because of the authority role clinicians hold, it is possible to impose one’s own opinions on the client if untrained. With this understanding I would agree with Gorgias that the persuader has the power to constrain. As the persuader (clinician) I can set boundaries around my constructed argument (opinion) that gets the audience (clients) to react and feel the way I need them to in order to sway them into a state that facilitates change. In essence, the job of the clinician is to use language–therapeutic techniques–to get clients to see where a problem exists and then teach clients the language necessary to change the issue; thereby giving the client ultimate power.

Win a Brand New iPhone 5!!!!!

Sep 10, 2011   //   by Richard Figueira   //   Blog  //  No Comments

****CONTEST****

Win a brand new iPhone 5 by writing a quote, submitting a thought, sharing an article. The person

with the most likes by the end of November will win. This will be tracked by FB itself. Get your

friends to “like” the page not just the comment!!!!!

All you have to do is click “like” and start typing!!!!

We at Anchor Counseling Center are remembering 9/11!

Sep 10, 2011   //   by Richard Figueira   //   Blog  //  No Comments

At Anchor Counseling Center, ten years ago the numbers “9″ and “11″ did not mean anything but were simply two numbers that were separated by, ironically, the number “10.”  Today, the numbers “9 and 11″ bring back memories of a tragic event and day that left many individuals, families, and ultimately a country scared and scarred for many years to come.

It was that day when this country lost 3,000 civilians due to 4 suicide bomb attacks.  New York City, as well as Washington, D.C., was physically affected losing some this country’s most visible and notable buildings, including the Pentagon.  Coinciding, passenger’s attempts to take control of the fourth hijacked jet crashed into a field in Pennsylvania – the jet’s intended destination also being Washington, D.C.

At “Ground Zero” thousands of police officers, fire fighters, EMS personnel, search and rescue dogs, construction workers, and civilian volunteers responded trying to find survivors and just lend a helping hand where needed.

During that dark and horrific morning the country took precautions to protect the President.  President Bush was continuously moved around the country until approximately 7pm.  When he returned to the White House, he addressed our nation.  His now famous speech echoed the country’s sentiments, “Terrorist attacks can shake the foundations of our biggest buildings, but they cannot touch the foundation of America.  These acts shatter steel, but they cannot dent the steel of American resolve.”  In a reference to the eventual U.S. military’s response he declared, “We will make no distinction between the terrorists who committed these acts and those who harbor them.”

Operation Enduring Freedom had begun.  The military captured and slowed down the Taliban within two months.  But, it would take our country and its military almost 10 years to capture Bin Laden.  On May 2, 2011, the US military captured and killed the mastermind behind the most devastating attack and day in this country’s history.

Today, many people are left with their own burning holes of empty feelings after losing loved ones.  On that day, our freedom, as we knew it was taken.  Some of us are still healing from the wounds of that day.  There is not much anyone can do for the many who suffered during that time, on that day, and in the days following.

At Anchor Counseling Center, we provide therapy and counseling to many people.  Although, many of our patients may have never felt a loss from this tragedy, they do, in their own way deal with loss, grief, anger, disappointment, sadness, and many other issues.

Whatever the feelings or cause, we are here to respond to your needs.  Anchor Counseling Center has over 20 clinicians in Cranston, East Providence, and Lincoln, RI.  While the help may not reach the gravity that the 300 or so first responders, who lost their lives faced on that fateful day on September 11, 2001- we are here to help; one family at a time.

May God bless America!  We and this entire nation are forever grateful to the brave men and women who protect and defend this wonderful country of ours every day.  You are the reason that we can proudly say that we are the “the land of the free and the home of the brave.”If you or someone you know need someone to talk to please contact us.

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Richard Figueira, LICSW

Clinical Director

Anchor Counseling Center

Rhode Island

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